Evaluation of Cardiovascular Risk Factors Among Adults With Perinatally Acquired HIV.

Background: Despite successful ART, people with HIV are at increased risk of non-AIDS-related comorbidities, including cardiovascular and metabolic disease. Adults with perinatally acquired HIV (PaHIV) may face additional risks due to lifelong HIV-related inflammation and ART exposure. We explored cardiovascular and metabolic risk factors in a cohort of adults with PaHIV. Methods: Case-note review of adults with PaHIV ≥18 years attending a UK specialist service. Hypertension was defined by World Health Organisation (WHO; ≥ 140/90 mmHg) and American Heart Association (AHA; ≥ 130/80 mmHg) guidelines. Standard lipid and blood pressure thresholds defined metabolic syndrome [triglycerides ≥1.7 mmol/L, high-density lipoprotein <1.04 mmol/L (men) and <1.29 mmol/L (women), BP ≥130/85 mmHg]. CVD risk was assessed using modifiable factors and Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores for coronary arteries (CAs) and abdominal aorta (AA). Results: The cohort included 225 adults with PaHIV; median age 27 (IQR 23, 30) years, 55% female, and 86% Black ethnicity. Median CD4 count 634 (IQR 438, 815) cells/μL and ART duration 19 (IQR 13, 22) years. About 83% had HIV-1 RNA <50 copies/mL. Hypertension was identified in 9% and 21% of participants by WHO and AHA criteria, respectively. Metabolic syndrome was present in 3%. Elevated PDAY scores ≥1 were observed in 57% for CA and 51% for AA. Conclusions: Despite viral suppression, over half the cohort had elevated PDAY scores, predictive of increased cardiovascular risk. WHO-defined hypertension rates were similar to an age-matched UK population; however, 1 in 5 were hypertensive by AHA criteria. Statin initiation guidelines may need adaptation for this population.